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Hearing Surveillance Chart--a tool for tracking serial audiometry results and predicting future hearing impairment.

High frequency hearing loss is related to noise-induced deafness. We decided to develop a method of recording serial audiogram results that would provide an accessible overview of trends for an individual. Health & Safety Executive (HSE) warning and referral levels for high frequency hearing losses were plotted against age. A third line was added to indicate a level of 'significant' handicap. This graph is inserted in each individual's hearing surveillance record. High frequency hearing loss results are plotted for each ear over time. Someone with known hearing loss but minimal deterioration will exceed the HSE warning level at every review, whereas someone with perfect hearing suffering a significant deterioration may not exceed the warning level initially. The latter should be of more concern to their current employer.

Audiometry↗

Heart rate response audiometry: bases, clinical techniques, and limitations.

Although a great deal of information is available concerning cardiovascular responsitivity to sensory stimuli, little is known regarding the pragmatic application of cardiac response measures to the problems of audiological assessment. Some relationships between arousal systems and cardiovascular function have begun to emerge, and the assessment of communicative behavior using HR response measures has become a more realistic goal, but the clinician who desires to utilize these techniques for audiological evaluation faces serious difficulties until further basic research has been conducted. Eisenberg (9) observed that instrumentation for measuring HR changes to auditory stimuli was research oriented and that measurement of HR data, although holding promise for the future, could not be realistically viewed as a clinical tool for audiological evaluation. Indeed, Eisenberg challenged audiologists to suspend the clinical application of these procedures until sufficient basic research evidence has accumulated to operationally define the problems at hand. Until that challenge is met, cardiotachometry will remain only a potentially rewarding procedure for assessment of the auditory system.

Acoustic Stimulation↗

Delayed feedback audiometry: reliability of repeated measures.

The test-retest reliability of hearing thresholds at 1000 Hz measured by a delayed auditory feedback procedure was compared with the reliability of thresholds obtained with voluntary responses to the same signal in 10 adults with normal hearing sensitivity. Thresholds for each procedure were obtained three times on each of 5 different days. Although the delayed feedback procedure yielded estimates of threshold which averaged 4.6 dB greater than those estimated by voluntary responses (p less than 0.05), there was no evidence that experience over time resulted in a change for the poorer in the precision of the test.

Adult↗

Correcting for ear canal collapse during audiometry.

The hearing thresholds of 20 subjects with normal hearing and normal ear canals and two subjects with collapsible ear canals were measured at octave frequencies from 250 to 8000 Hz under standard transducers (TDH-39) fitted with standard cushions (MX-41/AR) and experimental cushions (Telephonics 266CIII). When correction factors based on normal threshold differences were applied, thresholds obtained under the experimental cushion reasonably approximated the actual hearing of individuals with collapsible canals.

Adolescent↗

A modification of play audiometry to assess speech discrimination ability in severe-profoundly deaf 2- to 4-year-old children.

OBJECTIVE: The aim was to develop an assessment procedure that was independent of language and speech production ability, to test speech feature discrimination in severe-profoundly deaf children 2 to 4 yr of age. DESIGN: The procedure being trialed was adapted from existing procedures. The child was required to respond with a game-like motor response to a "change" in a speech stimulus that was being presented repeatedly through a speaker. The change occurred at randomly determined times, and false alarm responses were measured during the waiting periods (while the child waited for the change). Two- to four-yr-old normally hearing children and hearing-impaired children using hearing aids and a group of 4-yr-old hearing-impaired children using cochlear implants were assessed on the task. RESULTS: More than 82% of the 3- and 4-yr-old normally hearing and hearing-impaired children were able to complete the testing for the eight speech sound contrasts within three 20 minute sessions. Fifty percent of the 2-yr-old normally hearing and hearing-impaired children were able to condition and complete the task. All of the normally hearing children who completed the task successfully discriminated all speech sound contrasts. The performance of the hearing-impaired children using hearing aids was influenced by the degree of hearing loss and the type of speech contrast being tested. Similarly, the average performance of the children using cochlear implants was better for easier contrasts such as /ba/bi/ with contrasting vowel formant cues. CONCLUSIONS: This procedure has potential for use as a reliable clinical and research tool for assessing the development of auditory discrimination ability in 2- to 4-yr-old severe-profoundly deaf children.

Audiometry, Speech↗

Steady-state response audiometry in a group of patients with steeply sloping sensorineural hearing loss.

OBJECTIVES: The purpose of this study was to examine the predictive value of auditory steady-state response (ASSR) evoked potential thresholds and predicted behavioral thresholds in a group of children with steeply sloping sensorineural hearing loss (HL). STUDY DESIGN: Case series. METHODS: Twenty-nine children with sloping sensorineural HL underwent behavioral audiometric evaluation, impedance testing, distortion product otoacoustic emissions, and steady-state response testing. A t test was performed to compare the means of ASSR predicted behavioral thresholds and behavioral responses. Pearson correlation coefficients were calculated at each tested frequency, 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz, using the same data. RESULTS: Bracketed thresholds were obtained at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Nineteen ears were used in this evaluation. A comparison of threshold difference as a function of bracketing revealed that the means were statistically different (P < .05). The mean threshold differences were calculated, and Pearson r values were determined between the behavioral thresholds and the predicted thresholds using the Rance 95 algorithm. The results revealed no difference of means at 500 Hz between predicted and measured behavioral thresholds. Linear regression analysis revealed strong correlation at 500 Hz, 1,000 Hz, and 2,000 Hz. CONCLUSIONS: The GSI Audera appears to predict the configuration of HL in children with steeply sloping sensorineural HLs and over-predicts the severity of the loss by 15 to 20 dB above 500 Hz at each test frequency (1,000, 2,000, and 4,000 Hz). Correlation coefficients display a strong correlation at 500 Hz, 1,000 Hz, and 2,000 Hz.

Acoustic Impedance Tests↗

BSER audiometry in haemodialysis patients.

The object of this paper was to study the brain stem evoked response in 20 patients suffering from chronic renal failure and having haemodialysis, and to evaluate the effects of this treatment. A further 5 successful renal transplant patients were investigated to analyse the evolution of the brain stem conduction when the metabolic abnormality is removed. In the first group, the responses were minimally abnormal in 30% of cases before the dialysis. The dialysis session showed an improvement of the brain stem conduction. This variation was temporary and, 24 hours following the dialysis treatment, the patients showed the pathological values observed before the dialysis. The results of the successful transplanted patients were consistent with the data obtained in the dialysis group. Before transplantation the nerve impulse conduction was found to be abnormal in 3 subjects. These abnormalities disappeared completely after successful transplantation. These results support the view of those who favour the use of evoked potentials to follow the status of the central nervous system in uraemic patients.

Adult↗